Fast, reliable, imaging diagnosis and suitable treatment for emergency and trauma patients is still among the major logistical challenges for the clinical environment. When a medical emergency occurs, and particularly when a patient has multiple injuries, the earliest possible diagnosis and treatment is particularly important. For this reason, the first few hours after a patient arrives at a medical facility, perhaps in shock, are called the “golden hours”, as the effective use of this time is often of decisive importance for the further clinical course of the patient.
Best practices in emergency medical treatment management may involve interdisciplinary collaboration of anesthesia, radiology and trauma surgery, with the goal of diagnosing life-threatening injury patterns rapidly and promptly and contemporaneously initiating appropriate therapeutic actions. In the initial phase of emergency medical care, a team of 10-15 doctors, nurses and technicians can be involved. A wide variety of medical diagnostic equipment, techniques and protocols can be needed, depending on the nature of the medical emergency or injury.
Imaging modalities used for diagnostics are an essential component of the initial clinical phase of care. The relevant injuries or conditions should be diagnosed quickly and reliably, and life-saving therapeutic treatment is sometimes initiated and performed even during the ongoing imaging diagnostics. Moreover, the use of radiological interventional methods, such as balloon occlusion or CT-controlled ventricle catheter system for treating brain swelling, may be desirable.
Often, a trauma patient must be taken to a CT (computed tomography) examination room so that a complete imaging diagnosis can be made. The patient may then be returned to the trauma treatment room for further treatment or taken to another treatment room. Moving the patient between the various diagnostic equipment location wastes time during the “golden hour”.
Some more efficient arrangements for diagnosis and treatment in the trauma or emergency room do exist. For instance, with the Siemens AXIOM Vertix MD Trauma, it is possible to obtain digital 2D projection radiography images of the patient directly in the trauma room. This has the advantage of immediate availability and relatively effective physical access to the patient. A disadvantage is the restriction of the technology to 2D projection images.
From US Pg-Pub No. 2004/0001571 “System for Emergency Medical Care and Monitoring of a Patient”; a combination system of a computed tomography (CT) and a conventional 2D X-ray system is known. This approach permits use of computed tomographic imaging, partially 3D cross-sectional images, and the additional capability of analog 2D projection images made directly in the trauma room. From “Interdisziplinäre Schockraumversorgung: Personelle, apperative und räumliche-logische Konzepte in 3 Traumkrankenhäusern in Europa” [“Interdisciplinary Trauma Room Care: Concepts with Regard to Personnel, Equipment and Space Logistics in 3 Trauma Hospitals in Europe”], Der Radiologe 7-2002 and “Strukturierte radiologische Diagnostik beim Polytrauma” [“Structured Radiological Diagnostics in Polytrauma”], Der Radiologe 7-2002, principles are likewise described for improving patient care. However, these solutions to the problem have a disadvantage that a relatively large space is needed for the equipment and the necessary repositioning of the patient during the individual steps in examination, the limited capability of direct radiologically managed intervention, or the lack of capability of, for example, angiographic intervention. In existing equipment, analog imaging technologies may result in a further delay, in some circumstances, for the development of photographic material.
In co-pending U.S. patent application, Ser. No. 11/478,087, by J. Boese and B. Heigl, a floor-mounted robot with a C-arm X-ray system is described. System concepts are described with which a patient can be repositioned using a floor-mounted robot and a diagnostic X-ray examination can be performed using a floor- or ceiling- mounted C-arm X-ray system (radiation emitter and detector combination). These concepts, however, do not extend to the clinical emergency and trauma processes and are restricted to uses of X-ray examination or therapy. Mobile C-arm X-ray diagnostic equipment has been developed for this purpose, and has become well known in the medical art of surgical and other interventional procedures.
A C-arm X-ray configuration refers to C-shaped structural member having an X-ray source and an X-ray detector typically mounted at or near the ends open ends of the “C” such that a central ray of the X-radiation is orthogonal to the surface of a facing X-ray detector. The space within the C-shape of the arm and the aperture to the “C” provides room maneuvering the patient, or for the physician to attend to the patient with minimal interference from the X-ray support structure.
The C-arm can be mounted to permit rotational movement of the arm about two perpendicular axes in a spherical motion. The entire C-arm may also be translated in linear directions to facilitate positioning with respect to the patient.
When the C-arm X-ray system uses a real-time X-ray detector, the C-arm may be rotated about the patient so that computed tomography (CT) images may be obtained. In such a use, image data acquisition may take approximately 10 seconds with C-arm rotation through approximately 200 degrees.
Digital detector systems for projection radiography are becoming commonplace in the clinical environment, and may be used to facilitate the rapid acquisition of data with the C-arm system. Such digital detectors provide high spatial resolution while having a high quantum efficiency. Apart from reducing the patient radiation dosage, such detectors may be highly linear and have sufficient resolution and dynamic range to be used in CT applications.
FIG. 3 is a flow chart of one possible sequence of steps and procedures which may be performed in a trauma or emergency room. The number of steps, the type of diagnostic or treatment procedure employed depends on the nature of the injury or illness that has resulted in the patient being brought to the hospital.
When a patient has been brought to an emergency room (step 301), initial clinical examination and emergency action required by the circumstances presented is performed (step 310), such as intubation, patient monitoring, and in some cases the nature of the emergency is such that a determination of the next treatment steps can be made by a doctor or the like, such as immediate transfer to a treatment room or to a specialized diagnostic room (step 320). Otherwise, a series of actions are performed based on accepted medical practice so as to determine the nature and severity of the trauma, and to initiate an appropriate course of treatment. The actions may include the moving the patient to an X-ray machine (step 330), so as to determine if there is an injury to the bones, and to a CT machine (step 340) to obtain projection radiographic images so that a computed tomography (CT) image of a portion of the patient may be produced for diagnostic purposes. In the case of steps 330 and 340, the patient may have to be repositioned and moved outside the emergency room so that the X-ray or CT equipment may be employed. Subsequent to obtaining the X-ray or CT images, the patient may be returned to the emergency room (step 350). Sometimes these steps may have to be repeated if the data obtained is unsatisfactory or incomplete. Moving a patient takes time, and is particularly awkward when the patient is encumbered by intubation, or other monitors or treatment apparatus. After diagnostic data is obtained and interpreted, the patient is either treated in the emergency room or transferred to an interventional unit, a surgical unit or other care provider station (step 360).
The frequent movement of a patient between the various diagnostic devices takes time and personnel. Such movement also means that not all of the emergency room facilities are available at all times during the diagnostic period.